Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews

Chiara Arienti, Stefano G. Lazzarini, Alex Pollock, Stefano Negrini

Research output: Contribution to journalArticle

Abstract

Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a “low or critically low” quality, 23% “moderate” quality and 22% “high” quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.

Original languageEnglish
Article numbere0219781
JournalPLoS One
Volume14
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

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rehabilitation (people)
systematic review
stroke
Patient rehabilitation
Rehabilitation
Stroke
Meta-Analysis
Virtual Reality Exposure Therapy
Randomized Controlled Trials
Postural Balance
Tai Ji
Aptitude
Vibration
randomized clinical trials
Outcome Assessment (Health Care)
Databases
Equipment and Supplies
physical therapy
Electromechanical devices
Physical therapy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Rehabilitation interventions for improving balance following stroke : An overview of systematic reviews. / Arienti, Chiara; Lazzarini, Stefano G.; Pollock, Alex; Negrini, Stefano.

In: PLoS One, Vol. 14, No. 7, e0219781, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61{\%} of SRs focussed on the effectiveness of physical therapy, 20{\%} virtual reality, 6{\%} electromechanical devices, 4{\%} Tai-Chi, whole body vibration and circuit training intervention, and 2{\%} cognitive rehabilitation. The methodology of 54{\%} of SRs were judged to be of a “low or critically low” quality, 23{\%} “moderate” quality and 22{\%} “high” quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22{\%} of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.",
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